Does gestational hypertension increase the risk of future neurological disorders?

Gestational hypertension, preeclampsia and eclampsia are established risk factors for stroke and dementia later in life. However, it is not known whether these pregnancy complications are associated with an increased risk of new-onset neurological disorders within months to years after giving birth.To investigate this issue, Swedish researchers examined whether gestational hypertension, preeclampsia and eclampsia are associated with new-onset migraine, headache, epilepsy, sleep disorder or mental fatigue within months to years after giving birth. The cohort study used data from the Swedish Medical Birth Register from 2005–2018. Follow-up was conducted using the National Patient Register, which contains diagnoses from specialized inpatient and outpatient care. Patient follow-up started 42 days after delivery and continued for up to 15 years. The risk was calculated with Cox regression analysis and expressed as an adjusted hazard ratio (aHR) with a 95% confidence interval (95%CI). The researchers identified 659,188 first-time pregnant women with singleton pregnancies between 2005 and 2018. Women with a diagnosis of chronic hypertension (n=4,271) or a prepregnancy neurological disorder (n=6,532) were excluded. The primary outcome was a composite neurological outcome of migraine, headache, epilepsy, sleep disorder or mental fatigue.Results showed the following:The study analysis included 648,385 women (mean age 28.5 years at the time of their first pregnancy).Women with gestational hypertension (n=11,133), preeclampsia (n=26,797) and eclampsia (n=625) all had an association with increased risk for a new-onset neurological disorder (a composite of migraine, headache, epilepsy, sleep disorder and mental fatigue) compared with women with normotensive pregnancies.After adjustment for confounders, an increased risk of the composite outcome was seen for women with gestational hypertension (aHR, 1.27; 95% CI, 1.12–1.45), women with preeclampsia (aHR, 1.32; 95%CI, 1.22–1.42), and women with eclampsia (aHR, 1.70; 95% CI, 1.16–2.50), compared with normotensive pregnancies.When examining individual neurological outcomes, women with eclampsia had more than a five-fold increased risk of future epilepsy (aHR, 5.31; 95%CI, 2.85–9.89) compared with women with a normotensive pregnancy. Women with gestational hypertension had an increased risk of migraine (aHR, 1.39; 95%CI 1.19–1.63), as did women with preeclampsia (aHR, 1.25; 95% CI 1.13–1.38). Preeclampsia was also associated with an increased risk of headache (aHR, 1.51; 95%CI, 1.33–1.71) and epilepsy (aHR, 1.32; 95%CI, 1.07–1.63).No association was seen between gestational hypertension, preeclampsia and eclampsia and future increased risks of sleep disorder or mental fatigue. However, the authors caution that the prevalence of these outcomes was low and they could not exclude that an existing association remained undetected.The authors conclude that in this study, women with gestational hypertension, preeclampsia and eclampsia had a 20%-to-70% increased risk of developing neurological disorders (migraine, headache, epilepsy) within months to years following their first birth. When investigating the individual neurological outcomes, the strongest association was found between women with eclampsia and the development of epilepsy, with a five-fold increased risk compared with women with a normotensive pregnancy. The authors point out that most studies on maternal long-term outcomes after gestational hypertension, preeclampsia and eclampsia have focused on cardiovascular disease or long-term neurological complications, such as stroke, dementia and cognitiveimpairment. Guidelines currently recommend that women with gestational hypertension and preeclampsia be followed-up after delivery for their increased risk of cardiovascular disease. Based on these study results, however, the authors stress that healthcare providers should also pay attention to persisting or new-onset neurological symptoms at follow-up visits, since this group of women appears to be vulnerable to developing future neurological disorders.Reference:Friis T, Bergman L, Hesselman S, et al. Gestational hypertension, preeclampsia, and eclampsia and future neurological disorders. JAMA Neurol 2024; Published online December 23, 2024. (accessed December 23, 2024).

Does gestational hypertension increase the risk of future neurological disorders?

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